Reimbursement to providers will be based on:

Preferred providers contracted reimbursement fees

Contracted fees for pharmacies participating in the OPDP network

Immunizations billed by licensed flu shot clinic providers or student and county health clinics will be reimbursed at the in-network benefit level. The payment allowance will be based on the maximum plan allowable (MPA) for the geographic area.

Benefits will be based on policy provisions and covered immunizations will be limited to those that are considered the "standard of care" by the local medical community. Government agencies or medical associations such as the American Medical Association and Oregon Medical Association will set these standards for the state as a whole.

Flu vaccine billing process

If a member goes to a Moda Health preferred provider for a flu vaccine, the provider will submit a bill to Moda Health for reimbursement. This means no out-of-pocket expenses for the member.

OEBB members accessing immunizations and vaccines at a contracted OPDP network pharmacy can have their claims processed for covered benefits at the point of service by simply supplying their insurance information to the pharmacy. This means no out-of-pocket expenses for the member.

In some cases, members may need to pay for the immunization and bill Moda Health directly for reimbursement. Please note, members must submit a receipt for the vaccine to the address below to be eligible for reimbursement.

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